- sent STATE OF FLORIDA AGENCY FOR HEATH CARE ADMINISTRATION oe ee LAKELAND REGIONAL MEDICAL CENTER, Petitioner, Boe vs. CASE NO. 02-2692MPL". x, 8 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / ee FINAL ORDER THE PARTIES resolved all disputed issues and executed a ‘settlement agreement”, which is incorporated by reference. The parties are directed to comply with the terms of the settlement agreement”. Based on the foregoing, this proceeding ig CLOSED. DONE and ORDERED on this the / / day of — Lorducy , 2003, in Tallahassee, Florida. pr Lege a ia Rhonda M. Medows, MD, FAAFP, Secretary i agency for Health care administration PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY ALONG WITH FILING FER AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: Robert E. Puterbaugh, Esq. Peterson & Myers, P.A. Post Office Box 24628 Lakeland, Florida 33802-4628 Kim A. Kellum, Esquire Attorney for Agency AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Fort Knox Building 3, Mail Stop 3 Tallahassee, Florida 32308 J. B. Clark Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Jean Lombardi, Finance and Accounting, Ms 14 Art Williams, Medicaid Program Development MS 6 CERTIFICATE OF SERVICE See VE PERV ICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addressees by U.S. Mail on this the oa day of ree , 2003. '. Lealand McCharen, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop 3 Tallahassee, Florida 32308-5403 DEC-@5-20@2 13:43 P.a2 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION LAKELAND REGIONAL MEDICAL CENTER, Petitioner, vs. Case No. 02-2692MPI - a AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. Sh / ‘ SETTLEMENT AGREEMENT a Respondent, the State of Florida, Agency for Health Care Administration, and Petitioner, Lakeland Regional Medical Center, by and through the undersigned individuals, hereby stipulate and agree as follows: 1. This settlement agreement is entered into between the parties in order to resolve a dispute that arose as the result of an audit. 2, Ina final agency audit letter dated April 29, 2002, Petitioner was informed that the Agency sought recoupment in the amount of $97,052.70. A copy of the recoupment letter is attached to this agreement. 3. Petitioner challenged Respondent's action and requested a formal hearing regarding the claims in question. 4. Subsequently, the Respondent reviewed additional documentation. DEC-25-2282 13:43 P.B3 5. As a result of the additional review the overpayment was adjusted to $143.52. 6. The Petitioner agrees to pay the Agency $1,856.48 in investigative and legal costs. 7. The Agency agrees to allow the Petitioner, Lakeland Regional Medical Center, to pay the Agency the total sum of $2,000.00 within 60 days of execution of settlement agreement. 8. In the event the Petitioner fails to make any payment due hereunder, the Respondent may, at its option and upon fifteen days written notice to Petitioner, declare Petitioner in default, Its provider number shall be suspended until such time as the Agency receives payment of the balance in full. 9. Payments shall be made to: AGENCY FOR HEALTH CARE ADMINISTRATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, FL 32317-3749 10. Provider will cooperate in a comprehensive follow- up review within 6 months of the date of the Final Order in this case to ensure that provider is billing Medicaid correctly. 11. This settlement does not constitute an admission of wrongdoing or error by either party. However, the parties believe that this matter should be settled. 12. Both parties request that the Agency close the file in this case. DEC-45-2082 13:43 P,B4 13. Each party shall bear its own attorney's fees and costs. 14. This agreement represents the entire agreement between the parties regarding settlement of this case. No modification or waiver of any provision shall be valid unless a written amendment to the agreement is completed and properly executed by the parties. The signatories to this agreement, acting in a representative capacity, represent that they are duly authorized to act on behalf of the ve parties to the agreement. Venue for any action arising from oo this agreement shall be in Leon County, Florida. DEC-@5-2882 13:43 P.25 Dated this IG day of Sevlaney of 2007.3, AGENCY FOR HEALTH CARE ADMINISTRATION Valda Clark Christian General Counsel oh Agency for Health Care i Administration 2727 Mahan Drive Ft. Knox Building 3 Tallahassee, Florida 32308 whe Rufus Noble, Inspector General Agency for Health Care Administration 2727 Mahan Drive Ft. Knox Building 3 Tallahassee, Florida 32308 , 1 / aoe oo and Regional Medical Center 1324 Lakeland Hills Blvd. Lakeland, Florida 33805 7 fa re - Robert E. Puterbaugh, Esq. Peterson & Myers, P.A. Post Office Box 24628 oe Lakeland, Florida 33802-4628 pos Cc; Art Williams, Medicaid Program Integrity ok Willie Bivens, Finance and Accounting uo THTA P as

Docket for Case No: 02-002692MPI